Provider Demographics
NPI:1992009930
Name:COSTLEY, MICHELLE CORONA (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:CORONA
Last Name:COSTLEY
Suffix:
Gender:F
Credentials:FNP-BC
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2102 TREASURE HILLS BLVD
Mailing Address - Street 2:# 3.14406
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8736
Mailing Address - Country:US
Mailing Address - Phone:956-296-1437
Mailing Address - Fax:956-296-6842
Practice Address - Street 1:UNIMOVIL UNIT
Practice Address - Street 2:2102 TREASURE HILLS BLVD., #1.326 (BASE)
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550
Practice Address - Country:US
Practice Address - Phone:956-296-1700
Practice Address - Fax:956-296-1331
Is Sole Proprietor?:No
Enumeration Date:2011-01-05
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX670483363LF0000X
TXAP13866363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286369805Medicaid
TXH08MK73201OtherBCBS